BNF for Children 2011-2012

BNFC 2011–2012 15.1.1 Intravenous anaesthetics 631Child 1 month–12 years 1–2 mg/kg produces 5–10 minutes of surgical anaesthesia, adjustedaccording to responseChild 12–18 years 1–4.5 mg/kg adjustedaccording to response (2 mg/kg usually produces5–10 minutes of surgical anaesthesia). By intramuscular injectionNeonate 4 mg/kg usually produces 15 minutes ofsurgical anaesthesia, adjusted according toresponseChild 1 month–18 years 4–13 mg/kg (4 mg/kgsufficient for some diagnostic procedures),adjusted according to response; 10 mg/kg usuallyproduces 12–25 minutes of surgical anaesthesiaInduction and maintenance of anaesthesia(longer procedures). By intravenous administrationNeonate initially 0.5–2 mg/kg by intravenousinjection, followed by a continuous intravenousinfusion of 8 micrograms/kg/minute adjustedaccording to response; up to 30 micrograms/kg/minute may be used to produce deep anaesthesiaChild 1 month–18 years initially 0.5–2 mg/kg byintravenous injection followed by a continuousintravenous infusion of 10–45 micrograms/kg/minute adjusted according to responseAdministration for continuous intravenous infusion,dilute to a concentration of 1 mg/mL with Glucose 5%or Sodium Chloride 0.9%; use microdrip infusion formaintenance of anaesthesiaFor intravenous injection, dilute 100 mg/mL strengthto a concentration of not more than 50 mg/mL withGlucose 5% or Sodium Chloride 0.9%Ketalar c (Pfizer) KInjection, ketamine (as hydrochloride) 10 mg/mL, netprice 20-mL vial = £5.06; 50 mg/mL, 10-mL vial =£8.77; 100 mg/mL, 10-mL vial = £16.10PROPOFOLCautions see notes above; cardiac impairment; respiratoryimpairment; hypovolaemia; epilepsy; hypotension;raised intracranial pressure; monitor bloodlipidconcentration if risk of fat overload or if sedationlonger than 3 days; interactions: Appendix 1(anaesthetics, general)Contra-indications see notes aboveHepatic impairment use with cautionRenal impairment use with cautionPregnancy may depress neonatal respiration if usedduring delivery; max. dose for maintenance ofanaesthesia, 6 mg/kg/hourBreast-feeding breast-feeding can be resumed assoon as mother has recovered sufficiently fromanaesthesiaSide-effects see notes above; also hypotension,tachycardia, flushing; transient apnoea, hyperventilation,coughing, and hiccup during induction; headache;less commonly thrombosis, phlebitis; rarelyarrhythmia, headache, vertigo, shivering, euphoria;very rarely pancreatitis, pulmonary oedema, sexualdisinhibition, and discoloration of urine; serious andsometimes fatal side-effects reported with prolongedinfusion of doses exceeding 5 mg/kg/hour, includingmetabolic acidosis, rhabdomyolysis, hyperkalaemia,and cardiac failure, dystonia and dyskinesia alsoreportedIndication and doseInduction of anaesthesia using 0.5% or 1%injection. By slow intravenous injection or by intravenousinfusionChild 1 month–18 years adjust dose according toage, body-weight, and response; usual dose inchild 1 month–17 years 2.5–4 mg/kg; usual dose inchild 17–18 years 1.5–2.5 mg/kg at a rate of 20–40 mg every 10 seconds until responseInduction of anaesthesia using 2% injection. By intravenous infusionChild 3–18 years adjust dose according to age,body-weight, and response; usual dose in child 3–17 years 2.5–4 mg/kg; usual dose in child 17–18years 1.5–2.5 mg/kg at a rate of 20–40 mg every10 seconds until responseMaintenance of anaesthesia using 1% injection. By continuous intravenous infusionChild 1 month–18 years adjust dose according toage, body-weight, and response; usual dose inchild 1 month–17 years 9–15 mg/kg/hour; usualdose in child 17–18 years 4–12 mg/kg/hour,adjusted according to responseMaintenance of anaesthesia using 2% injection. By continuous intravenous infusionChild 3–18 years adjust dose according to age,body-weight, and response; usual dose in child 3–17 years 9–15 mg/kg/hour; usual dose in child 17–18 years 4–12 mg/kg/hour, adjusted according toresponseSedation of ventilated children in intensive careusing 1% or 2% injection. By continuous intravenous infusionChild 16–18 years 0.3–4 mg/kg/hour, adjustedaccording to responseInduction of sedation for surgical and diagnosticprocedures using 0.5% or 1% injection. By slow intravenous injectionChild 1 month–18 years dose and rate ofadministration adjusted according to desired levelof sedation and response; usual dose in child1 month–17 years 1–2 mg/kg; usual dose in child17–18 years 0.5–1 mg/kg over 1–5 minutesMaintenance of sedation for surgical and diagnosticprocedures using 0.5% injection. By intravenous infusionChild 17–18 years dose and rate of administrationadjusted according to desired level of sedationand response; usual dose 1.5–4.5 mg/kg/hour(additionally, if rapid increase in sedation required,by slow intravenous injection 10–20 mg)15 Anaesthesia